of time and reduce the
amount of opioids
patients need."
Still, single-shot
intraarticular injections
can be very effective for
patients who don't want
to go home with a
catheter or pain pump
or during cases involv-
ing surgeons who don't
want blocks placed.
While the long-acting
local anesthetic liposomal bupivacaine (Exparel) has enjoyed a virtual
monopoly on the market, that could change in the near future. "There are
a lot of exciting formulations in the pipeline," says Dr. Gan.
For example, Heron Therapeutics has developed a combination of the
long-acting local anesthetic bupivacaine and a low dose of the nons-
teroidal anti-inflammatory agent meloxicam in a drug called HTX-011,
which is slated for FDA review in March. "The nonsteroidal makes the pH
level more neutral and therefore improves the absorption of the local
anesthetic, which is a prolonged version of bupivacaine," says Dr. Gan.
"The data suggests it can work for 48 hours, and perhaps up to 72 hours."
Dr. Gan says another long-acting bupivacaine formulation in development
by drug manufacturer Durect has been sent to the FDA for review and
promises to provide several days of pain relief. He also points to a new local
anesthetic collagen matrix, which works by impregnating a local anesthetic
into the sponge-like material and gradually releasing it over 48 hours to 72
hours.
J A N U A R Y 2 0 2 0 • O U T PA T I E N T S U R G E R Y. N E T • 3 1
•
TRIED
AND
TRUE
Patients
who
receive
nerve
blocks
are
less
prone
to
opioid-
associated
side
effects
like
respiratory
distress
or
PONV,
and
are
discharged
more
quickly
following
surgery.
Pamela
Bevelhymer,
RN,
BSN,
CNOR
